Choosing the right dialysis option for your critically ill patient. What's right for a hyperkalemic patient may be wrong for one with shock.

Critically ill patients frequently require dialysis. Options include intermittent hemodialysis, peritoneal dialysis, and various forms of continuous extracorporeal therapy. Intermittent hemodialysis is useful for hemodynamically stable patients who can tolerate rapid solute and fluid removal. Peritoneal dialysis, which is underused in the ICU, offers two distinct advantages: It does not require vascular access and systemic anticoagulation is not necessary. Continuous extracorporeal therapies are better tolerated by hemodynamically unstable patients, since these techniques can remove large amounts of fluid over an extended period. Base your choice of therapy on the patient's condition and needs, the options available at your institution, and the experience of you and your staff.